OBJECTIVE: To evaluate the extent of and factors associated with urine testing in US pediatric ambulatory visits for symptoms commonly associated with viral illness. STUDY DESIGN: We analyzed a nationally representative, cross-sectional sample of ambulatory clinic and emergency department (ED) visits among children 2 months to 17 years old (2014 through 2019 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey). Using reason for visit classification codes, we identified visits for respiratory symptoms, diarrhea, or rash
termed "viral symptoms" without reported localizing genitourinary symptoms. We assessed the proportion of these visits with urine testing (urinalysis and/or urine culture) and evaluated factors associated with urine testing using logistic regression. RESULTS: Of 71.3 million (95% CI 64.7-78.0 million) pediatric ambulatory visits per year, 61% (95% CI 59-63%) were for viral symptoms without reported genitourinary symptoms. Urine testing at these visits accounted for 38% (95% CI 30-47%) of overall urine testing. Such testing occurred more frequently at ED visits (8.3%
95% CI 7.4-9.3%) compared with clinic visits (4.4%
95% CI 2.5-7.7%). At ED visits, the adjusted probability of urine testing in the context of viral symptoms was lowest for males age 2 months to <
2 years (5%
95% CI 3-6%) and highest for females age 12 through 17 years (20%
95% CI 16-24%), and females age 6-11 years (13%
95% CI 11-16%). CONCLUSIONS: Urine testing in children with symptoms of viral or other non-UTI illnesses occurs frequently at ambulatory visits. This potentially avoidable testing disproportionately occurred in older age groups with low clinical risk of UTI.